Provider Demographics
NPI:1205237567
Name:DR. PAUL DODSWORTH DDS PC
Entity type:Organization
Organization Name:DR. PAUL DODSWORTH DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:DODSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-240-2420
Mailing Address - Street 1:1100 E MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-4063
Mailing Address - Country:US
Mailing Address - Phone:970-240-2720
Mailing Address - Fax:970-240-2740
Practice Address - Street 1:1100 E MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4063
Practice Address - Country:US
Practice Address - Phone:970-240-2720
Practice Address - Fax:970-240-2740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000064401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty